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Aesthetics Practice Today

ThermiSmooth: An Anti-Aging 'Lunch-Time' Procedure
February 2, 2017 9:42 AM by Mina Grasso

The trend towards non-invasive, no-downtime procedures with little to no discomfort continues to rise. Aesthetic procedures that can be performed as a “lunch time” procedure continue to increase in demand.

ThermiSmooth, using radio frequency energy, improves the appearance of aging skin by tightening and improving collagen production over time. A unique hand piece is used to deliver the energy over the surface of the skin. When controlled, sustained heat is delivered to a treatment area and collagen is stimulated to contract, resulting in the skin tightening. Collagen production and improved circulation due to angiogenesis contributes to plump and more youthful skin.

ThermiSmooth can treat various areas of the face, such as the jowls, forehead, cheeks, and around the lips, as well as the neck. This procedure is ideal for fine skin around the lips, upper eyelids and lower eyelids.

Most patients can see improvements immediately after the first treatment. Thicker skin with overall improved quality and appearance develops over the following 3 to 6 months. ThermiSmooth is ideal for mild to moderate wrinkles and minor texture conditions. Extensive sun damage, texture irregularities or greater skin laxity may require more aggressive approaches, requiring more downtime. A surgical approach or other laser therapies might be a better approach to meet the patient’s needs.

A series of 4 or more of ThermiSmooth treatments every 2 weeks is recommended with maintenance every 6 months or sooner, depending on the desired results. Depending on the area(s) treated, a treatment session can take as little as 5 to 30 minutes. Patients can return to work or social engagements immediately. Patients will experience heat during the procedure with no pain and no bruising. Minimal to no redness may be seen.

Gradual improvement in skin quality and laxity can be experienced using ThermiSmooth as an anti-aging “lunch-time” procedure.


7 Ways to Defy Aging without Surgery
January 25, 2017 9:54 AM by Mina Grasso

Pushing the Needle

Patients demand a nonsurgical approach with little to no downtime to defy aging and squeeze into their social calendars or their pocket book. Those who fear surgery would prefer the needle to the knife. The following are 7 ways to defy aging without surgery.

1. Neuromodulators

Botox® or Dysport® can be used to relax dynamic facial muscles by blocking the nerves that contract the muscles, resulting in fewer and softer appearance of wrinkles and smoother skin. Common areas that are treated include the frown lines, crow's feet and forehead. A youthful brow lift can be created. Neuromodulators can be used in the lower face to reduce wrinkles around the lips, dimpling of the chin, relax the mental crease across the chin, improve the appearance of the marionette lines and reduce the downward-turned corners of the lips. In addition, a more defined neckline can result with injections of the platysmal bands in the neck. With strategic placement, patient's can look less angry or sad and overall more refreshed, happy and youthful.

2. Liquid Facelift

A variety of tissue fillers and collagen activators used to replace volume can be used in combination with Botox® or Dysport® to relax dynamic muscles. Liquid facelift can erase fine lines and wrinkles as well as recontour, reshape, reposition and lift sagging skin. Liquid facelifts can result in a more youthful appearance and eliminate the need for facial surgery. A non-surgical nose job can be performed in minutes. Asymmetries can be corrected. Ideal facial proportions for men and women with ethnic consideration can be improved. Replacing lost volume in the hands can rejuvenate their appearance to match the face.

3. Kybella®

A "double chin" or fullness of the neck negatively impacts an individual, causing them to often be perceived as heavy or older. This condition is usually associated with genetics, aging and/or weight gain. Kybella® contains a naturally occurring molecule, which destroys fat cells permanently while leaving other tissue unaffected. An average of 2 to 4 office injection sessions can result in an individual appearing to have lost weight and look younger.

4. Microneedling

Microneedling utilizes a pen shaped tool with very fine needles to create micro punctures in the skin. Common uses for microneedling include acne scarring, surgical or traumatic scars, hyper or hypopigmentation, melasma, pore reduction, fine lines and wrinkles, skin laxity, other skin texture disorders and overall rejuvenation of the skin. Microneedling can be performed on the face or other body parts. The micro punctures in the skin create controlled microtrauma of the tissue and stimulates the skin cells to proliferate. Microneedling prompts the body's repair mechanism. As cells proliferate, new tissue is formed with new collagen, elastin fibers and improved circulation to the area. Microneedling results in plumper, thicker skin, improved texture, reduced pore size, improvement in pigmentation, fine lines and wrinkles.

5. Platelet Rich Plasma

Platelet rich plasma is a revolutionary procedure gaining popularity in aesthetics. Orthopedic surgery and cardiac surgery are utilizing a patient's own rejuvenating properties with platelet rich plasma for facial rejuvenation, tissue repair and healing. PRP is now being used in a variety of aesthetic applications combined with various skin rejuvenation modalities, for scalp rejuvenation for hair loss, scar rejuvenation, the P-Shot® for men and O-Shot® for women for vaginal rejuvenation, improved sexual function and incontinence.

6. Sclerotherapy

Unsightly leg and hand veins are usually associated with aging. A solution is injected into the veins, which causes the veins to collapse. The collapsed veins usually fade within a few weeks. In some instances it may take several months, but appropriate intervention during the healing process may facilitate more rapid fading. An average of 1 to 4 sessions are required. Patients can return to work immediately. Compression hose are recommended for 1 to 2 weeks. Patients are advised to walk 20 minutes twice a day to prevent blood clots. Heavy lower body exercises should be avoided such as squats

7. Silhouette InstaliftTM

The Silhouette InstaliftTM is a breakthrough facial rejuvenation procedure that lifts sagging facial skin without the need for surgery, scars or general anesthesia.

The Silhouette InstaliftTM procedure involves insertion of resorbable sutures with bidirectional biodegradable cones to lift the deeper layers of the skin and recontour the face. This office procedure takes approximately 30 to 45 minutes to perform.

The cones engage with the subcutaneous tissue and create a mechanical fixation with traction, acting as an anchor resulting in immediate lifting of the skin. The regenerative benefits result from collagen stimulation and subsequent encapsulation of the suture. This biological fixation of tissue maintains the lift. Collagen is produced over time, and patients experience a gradual and natural improvement in volume and shape of the cheeks, midface and jowls.

Top 6 Aesthetic Procedures from 2016
January 4, 2017 9:41 AM by Mina Grasso

1. Microblading

Microblading for eyebrows, which is also known by a variety of names such as microstroking, feather touch, eyebrow embroidery, 3-D eyebrows and hair-like strokes, has become an increasingly popular form of cosmetic tattooing or permanent makeup.

Microblading enhances the appearance of the eyebrows with simulated hairs in areas of missing eyebrow hairs or to create a fuller and more attractive eyebrow shape. Cosmetic tattoo pigment is implanted using a hand tool with extremely fine-gauged needles fused together in a linear fashion to create a more fine and crisp hair stroke.

2. Coolsculpting with the CoolAdvantage

The proprietary CoolSculpting® cutting edge, controlled-cooling technology launched a new family of applicators called CoolAdvantageTM earlier this year. In the past decade, millions of treatments have been performed worldwide. The CoolAdvantageTM applicator with adaptable configuration and enhanced cup design increases direct tissue contact, uses lower temperatures and treats a larger area in nearly half the treatment time, safely and efficaciously. It is a more comfortable treatment with less suction, resulting in lower risk of bruising. This is the one and only FDA-approved procedure to permanently destroy fat cells while leaving normal tissue uninterrupted.

 3. Liquid Facelift

A variety of tissue fillers and collagen activators used to replace volume can be used in combination with a Botox or Dysport to relax dynamic muscles. Liquid facelift can erase fine lines and wrinkles as well as re-contour, reshape and re-position and lift sagging skin. Liquid facelifts can result in a more youthful appearance and eliminate the need for facial surgery.  A non-surgical nose job can be performed in minutes. Asymmetries can be corrected.

4. Kybella

Men and women often complain of disliking their profile due to their undesirable "double chin" or fullness of their neck due to submental and submandibular fat deposits under the chin or jawline. This condition is usually associated with genetics, aging and/or weight gain. It may be seen in patients who are within their ideal weight. The appearance of neck convexity or fullness negatively impacts these individuals, and they are often perceived as heavy or older.

Kybella contains a naturally occurring molecule that destroys fat cells permanently while leaving other tissue unaffected.

5. ThermiVA

ThermiVA is a revolutionary solution to restore feminine youthfulness for our patients who desire cosmetic enhancement of the vulva and have experienced the additional benefits of resolving their incontinence and have reported improved orgasms. Radiofrequency is used to smooth and tighten skin, vaginal mucosa and muscles. Immediate contraction and remodeling of collagen occurs and continues to improve. It is believed that incontinence and sexual function is improved by tightening of the pelvic floor, and the thermal input may stimulate chemotaxis and release growth factors, resulting in angiogenesis and neurogenesis, improving lubrication and sensation. ThermiVA is a non-invasive comfortable procedure that requires absolutely no downtime.

6. Platelet Rich Plasma

A revolutionary procedure gaining popularity in aesthetics, orthopedic surgery and cardiac surgery is utilizing a patient's own rejuvenating properties with platelet-rich plasma (PRP) for facial rejuvenation, tissue repair and healing.  PRP is now being used in a variety of aesthetic applications combined with various skin rejuvenation modalities, for scalp rejuvenation for hair loss, scar rejuvenation, the P-Shot (for men) and O-Shot (for women looking for vaginal rejuvenation), improved sexual function, and incontinence.

The CoolAdvantage Rage to Freeze Fat
December 21, 2016 9:55 AM by Mina Grasso
The proprietary CoolSculpting cutting edge, controlled-cooling technology launched a new family of applicators called CoolAdvantage earlier this year. In the past decade, millions of treatments have been performed worldwide. The CoolAdvantage applicator with adaptable configuration and enhanced cup design increases direct tissue contact, uses lower temperatures and treats a larger area in nearly half the treatment time, safely and efficaciously. It is a more comfortable treatment with less suction, resulting in lower risk of bruising. This is the one and only FDA approved procedure to permanently destroy fat cells while leaving normal tissue undisrupted. 

When thinking about CoolSculpting, most patients talk about the abdomen or love handles. CoolAdvantage can treat more fat in half the time. Areas that are commonly treated include fat located around the bra, back, arms, inner thighs, saddlebags and banana roll. The CoolMini, also a 35-minute treatment, is specific to smaller areas such as double chin, bra fat, above the knees and other small fat bulges. The following are the different adaptable CoolAdvantage applicators:

  • CoolFit Advantage is ideal for vertical areas of fat, such as the inner thigh.
  • CoolCore Advantage best matches the contours of the abdomen.
  • CoolCurve+ Advantage is the applicator of choice for flanks.
  • CoolMax Advantage is best for larger areas of fat on the abdomen

Some patients can start to see slight improvement in as little as 3 weeks. The "wow factor" is usually noticed around 3-4 months. Each treatment cycle permanently destroys 20-25% of the area treated. Two or more treatment cycles per area are usually recommended, depending on the amount of desired fat destruction. Additional treatments in the same or multiple areas may enhance the desired aesthetic effect. As long you can "pinch an inch," we can freeze the fat.

CoolSculpting has enhanced the male population in the aesthetic world. The CoolAdvantage will continue to increase in popularity for men, as well as women, with treatments that are more tolerable while requiring less time.

Gentle Lip and Fine Line Restoration
December 8, 2016 11:03 AM by Mina Grasso
The evolution of injectable fillers has gone from fine-line fillers, like bovine collagen in the 1990s, to more volumizing fillers, such as the various brands of hyaluronic acids over the following two decades. Now, the revolutionary filler, JUVÉDERM® VOLBELLA®, is a new fine-line and softer filler for lips, consisting of a smoother hyaluronic acid that lasts longer. 

JUVÉDERM® VOLBELLA® can be used in vertical lip lines (smoker's lines), marionette lines, and fine lines around the eyes and cheeks. Fine lines and wrinkles can appear airbrushed after treatment due to the smoother, softer consistency of Volbella®. Volbella® can be used to define lip contours, enhance the cupid's bow, and give the lips a gentle hydrated, natural, silky, and youthful appearance. 

Volbella® uses Allergan's proprietary Vycross technology, which delivers an ultra-smooth gel that is responsible for the natural look and feel while providing improved duration. Traditionally, lip fillers lasts about 6 months, with softer products lasting closer to 3 months. Satisfaction rate is extremely high with Volbella®. In clinical studies, 90% of test patients reported natural looking lips with more than 80% of them still satisfied with their results after one year. Volbella® has a lower HA concentration, which makes it less hydrophilic (less likely to absorb water), which considerably reduces swelling compared to other fillers. It is formulated with lidocaine to provide a more comfortable treatment.

Patients have a fear of looking unnatural. Many times I hear them say, "My husband does not want me to do my lips." They voice their fears about having "puffy lips," "trout pout," or "sausage lips." Patients recall vivid images of beautiful stars with distorted, over-plumped lips.

Volbella® can provide a more gentle restoration, giving the lips a softer, smoother, silky, and more natural appearance that many desire. In addition, vertical lip lines (smoker's lines), fine lines around the eyes, cheeks, and marionette lines can now appear "airbrushed" and not "puffy."
Lift Sagging Skin Non-Surgically
November 17, 2016 10:08 AM by Mina Grasso
One of the biggest challenges we face in the aesthetic arena is the lack of downtime for those with demanding schedules with family, work, and social engagements. Most patients that we see in our clinic are not quite ready for a surgical approach due to various reasons. Some of these reasons may include high cost of surgery, fear of surgery or anesthesia, young patients not ready for a surgical facelift, or older patients who are not surgical candidates.

The Silhouette Instalift, newly cleared by the FDA, is an exciting option for lifting sagging skin with minimal to no downtime. Instalift has been a popular and safe and effective procedure performed in Europe for many years. 

The Silhouette Instalift procedure involves insertion of resorbable sutures with bidirectional biodegradable cones. Local anesthetic is injected into the insertion and exit sites. A series of threads are placed parallel to each other along a vector starting from the nasal labial folds and jowls approximately a centimeter apart along the cheeks towards the ears. Three to five threads can be used per side. Suspension sutures may contain a series of 8, 12, or 16 cones. This office procedure takes approximately 30-45 minutes to perform.

Once the Silhouette Instalift suspension sutures are implanted, the skin is gently advanced over the cones. The cones engage with the subcutaneous tissue and create a mechanical fixation with traction and acts as an anchor resulting in immediate lifting of the skin. Collagen production is stimulated and subsequent encapsulation of the suture in collagen takes place. This creates a biological fixation of the tissue, which maintains the lift. Collagen is produced over time and patients experience a gradual and natural improvement in volume and shape of the cheeks, midface, and jowls. The sutures dissolve over time.

Silhouette Instalift is made from Polyglycolide/L-lactide (PLGA - 18%), a well-known biomedical copolymer that is generally well tolerated in the body. It has a long history of use as a resorbable suture, and its breakdown process has been extensively studied. Silhouette Instalift combines the regenerative benefits of the cones, which are made up of a synthetic material called poly-l-lactic acid (PLLA - 82%), which is also used as Sculptra. Sculptra is used as a biostimulator of collagen to provide long-lasting volume and contour in addition to the lift resulting in firmer and more youthful skin. Sculptra has been used over a decade for volume replacement in aesthetics and was first approved for treatment of lipoatrophy. We have had much success in use of Sculptra alone with high patient satisfaction. 

Setting realistic patient expectations for what Silhouette Instalift can deliver results in increased patient satisfaction. Although temporary, the Silhouette Instalift may provide benefits up to 18 months or more and may appeal to patients looking to get a non-surgical facelift and look refreshed, without surgical scars or downtime.

Collagen Lift Facial for that Special Event
November 9, 2016 11:38 AM by Mina Grasso
Facial rejuvenation is frequently sought after in preparing for special events, such as weddings, reunions, and holiday celebrations. Men and women desire healthy, youthful skin to look refreshed. In addition, they want results without the undesirable downtime.

A new frontier in aesthetic medicine is a patented technologydermoelectroporation (DEP) that uses a device called Collagenizer II to provide a collagen lift facial.

Collagenizer II is used for transdermal delivery of macromolecules, such as collagen and hyaluronic acid, through the skin. These macromolecules have usually been delivered by injection but can now be delivered transdermally by using this DEP technology. More applications (including Botox without needles) are being performed using Collagenizer II for cosmetic improvement of wrinkles or for excessive sweating.

The collagen lift facial starts with a brief, superficial microdermabrasion treatment to exfoliate the stratum corneum layer and to stimulate vascularization. The Collagenizer II, using DEP technology, utilizes the skin's water-based intercellular channels to promote transdermal delivery. This technology is different than electrophoresis, microcurrent, and galvanic devices because of its unique, continuous, low-reversed polarity current. The delivery process does not change the properties of the product delivered.

The Collagenizer II increases the skin permeability to allow transdermal delivery of micromolecules and macromolecules for the first time. It introduces energy and delivers a collagen-based gel, which contains an injectable, medical-grade, and organic bovine collagen, along with hyaluronic acid and is delivered transdermally.

The collagen lift facial provides cell activation and acceleration of collagen synthesis and prevents oxidation, DNA damage, and UV-induced cell damage, as well as reduction in undesired pigmentation, acne, and other skin irregularities. Regenerating properties of connective tissue is stimulated.

The collagen lift facial is a non-invasive, non-traumatic procedure without the risk of injection bruising. It has the capability of delivering micro- and macromolecules and provides long-lasting, anti-aging effects.
Advancements in Permanent Eyebrow Makeup
October 19, 2016 9:36 AM by Mina Grasso
Permanent makeup, or microblading, for eyebrows has become an increasingly popular form of cosmetic tattooing, a result of recent advancements in needle technology. It is known by a variety of names such as microstroking, feather touch, eyebrow embroidery, and hair-like strokes.

Microblading enhances the appearance of the eyebrows by simulating hairs in areas of missing eyebrow or creating a fuller and more attractive eyebrow shape. Cosmetic tattoo pigment is implanted using a hand tool with extremely fine-gauged needles fused together in a linear fashion to create a more fine and crisp hair stroke. The limitation with use of traditional cosmetic tattoo machine needles is the size of the needle usedit results in larger hair strokes. In addition, the vibration of most machines is less conducive to creating crisp, clean lines.

Cosmetic tattooing using microblading requires the technician to have artistic ability. The patient's facial features, gender, ethnicity, and natural hair pattern characteristics and patterns must be respected when microblading. The illusion of actual hair strokes can appear 3-D, creating a natural appearance.

Adversely, microblading can result in complications, like patient dissatisfaction due to shape, size, color, pigment migration, or asymmetry. Allergy reaction to pigment used or aftercare products can occur.

Although uncommon, more serious complications such as transmission of blood-borne pathogenic organismsHepatitis C, HIVcan occur. Cosmetic tattoo artists should hold appropriate licenses and registrations, including annually completing and passing a blood-borne pathogen certificate exam. Aseptic technique, clinical grade equipment, and supplies must be usedincluding sterile single-use needles when performing microbladingin order to minimize the risk of these serious complications.

Men and women can benefit from microblading eyebrows. Desired enhancement of brow hairs missing due to trauma; hormonal imbalance; autoimmune conditions (such as alopecia, where complete loss of eyebrow hairs can occur); or those who desire darker, fuller, and a more attractive, natural-appearing eyebrows are made possible through microblading.

Intimate Lightening: Using A Revolutionary Transdermal Delivery System
October 5, 2016 9:23 AM by Mina Grasso

Intimate lightening is the process of improving the cosmetic appearance of the skin surrounding the vulva, groin, upper inner thighs, and anal area. As aesthetic procedures like laser hair removal, Brazilian waxing, and radiofrequency vaginal rejuvenation become increasingly popular, patients discover undesired, excessive pigmentation and uneven skin tones where the skin color is darker than the rest of their body. The darker the skin type, the darker pigmentation can develop. One of the most common causes of increased pigmentation is friction from clothing.

Around 2005, the adult entertainment industry inspired and popularized anal and vulvar bleaching. Many patients aware of their increased pigmentation felt self-conscious with intimacy, especially when re-entering the dating scene.

Intimate lightening, often referred to as anal or vulvar bleaching, is usually performed in a spa setting using mild fruit acids and other bleaching agents. Medical spa settings may use stronger acids and solutions. Extreme caution needs to be taken using acids and other bleaching agents due to potential risk of burning and irritation. These can increase pigmentation, discoloration, and scarring. Cases of scars resulting from strictures of the peri-anal skin, which cause tears at the anal opening, have been reported. Severe cases have led to rectal/fetal incontinence.

A revolutionary technology using dermoelectroporation (Collagenizer II) for transdermal delivery of macro-molecules has been a well-accepted, comfortable, and effective method to lightening skin surrounding the vulva, groin, upper inner thigh, and anus without the use of harsh chemicals.

Dermoelectroporation technology utilizes the skin's water-based intercellular channels to promote transdermal delivery. This technology is different than electrophoresis, microcurrent, and galvanic devices with its unique, continuous, and low-reversed polarity current. The Collagenizer II increases the skin's permeability to allow transdermal delivery of micro-molecules and macro-molecules for the first time. It is noninvasive with long-lasting effects.

Intimate lightening is performed using the Collagenizer II for transdermal delivery of an oil-soluble, stable, bio-available form of vitamin C, nonapeptide-1, and arbutina lightening and brightening property made from a combination of bearberry, cranberry, blueberry, and mushroom extracts. This solution does not contain hydroquinone or kojic acid as bleaching agents. Some controversy surrounds using hydroquinone and kojic acid due to concerns of carcinogenicity and mutagenicity in certain animal studies. They are banned in some countries.

Intimate lightening takes about 15 minutes per treatment. The results are effective, long-lasting, and can be maintained. A series of 6 treatments performed weekly, followed by monthly maintenance treatments, and a daily application is recommended. Darker pigmentation may require more treatments.

Patients who desire intimate lightening now have a noninvasive, safe, gentle, pain-free option to obtain a more even tone and brighter skin, providing long-lasting results that can be maintained and improve their confidence with intimacy.
10 Popular Pre-Wedding Makeovers
September 21, 2016 10:10 AM by Mina Grasso

Special events stimulate excitement and anxiety not only for the obvious bride and groom but also for those intimately involved, such as the parents of the bride and groom. Many have not seen family members or acquaintances for years and will usually meet new family members, and they want to look their best.

Patients who present for pre-wedding rejuvenation want to look better but are usually reserved with fears of looking bruised, puffy and unnatural. Most desire to look younger, healthier, less tired and more refreshed with a natural look. In addition to facial rejuvenation, body shaping and weight loss is usually part of the plan.

The 10 most popular pre-wedding makeovers include the following procedures:

  1. Botox for dynamic wrinkles
  2. Volume replacement with tissue fillers such as Restylane, Juvederm or Voluma
  3. Skin rejuvenation with non-ablative lasers or intense pulsed light
  4. Skin tightening with radiofrequency, non-invasive ThermiSmooth or minimally invasive Injectable RF ThermiTight
  5. Laser treatment for facial veins or brown spots
  6. With more time for planning, some patients choose CO2 fractional laser resurfacing for deeper wrinkles, which requires more social downtime
  7. Destruction of unwanted fat bulges can be accomplished by freezing fat with Coolsculpt...
  8. ...or Kybella to dissolve the fat. Multiple treatments over several months may be required for Coolsculpt and Kybella to obtain desired results
  9. Treatment of unsightly leg veins with sclerotherapy are popular especially for spring and summer weddings. Multiple treatments may also be required
  10. Rapid weight loss is attempted by the very motivated. It's not unusual to hear patients say they got close to their ideal weight for the wedding but were unfortunately unable to sustain it. The Burn Fat Rx program is a lifestyle change, education and guidance for sustainability

Realistic expectations must be set with appropriate timing, especially to avoid evidence of bruising or swelling. Some results can be experienced within one to two weeks while others, as described, may require multiple treatments over several months.

Laser Treatment for Peri-orbital Veins
September 7, 2016 8:42 AM by Mina Grasso

Peri-orbital vascular lesions distract from the beauty of a person's eyes. Our genes are to blame for the most part. The presence of red or green vascular lesions under the eyes gives the appearance of dark circles, which makes an individual look tired or older and can affect their self-esteem and self-confidence.

Peri-orbital veins become more prominent as we age due to the thinning of skin from collagen and elastin changes related to hormonal and environment influences. In addition to aging, the loss of fat pads around the eyes is accelerated in those who exercise excessively or experience rapid weight loss.

Patients are not usually aware that these veins can be treated. Laser vascular treatment of peri-orbital veins can reduce or eliminate the appearance of these vascular lesions. These can appear as fine red vessels less than 1 mm to larger reticular green veins 3 to 4mm in size. The laser energy coagulates the vascular lesions then shrinks and fades or completely eliminates the veins in one or a series of treatments.

The ideal vascular laser is a 532nm 1064nm wavelength, short-pulsed (nanosecond) with adjustable spot size and pulse duration to treat various sizes of vascular lesions at different depths.

Patients with all skin types can be treated with the 1064nm wavelength, but darker skin types have a higher risk of hyperpigmentation with the use of the 532nm wavelength. Contact cooling, with the ability to pre-cool the epidermis to reduce the initial skin temperature and post-cool the epidermis to extract heat from tissue to help prevent epidermal injury, is critical to providing a safer procedure.

With the variable spot size and pulse duration to treat various sizes of vessels, as well as the protective pre- and post-cooling, minimal to no downtime is required post procedure. Alternative options often lead to bruising and swelling.

A laser specialist must take extreme caution when treating vascular lesions around the eyes. The potential danger of eye injuries can occur using these wavelengths if appropriate precautions are not taken.

Reducing or eliminating peri-orbital vascular lesions can improve the appearance of many patients. By reducing the appearance of the dark circles, patients can look more refreshed and less tired, improving self-esteem and self-confidence.

ThermiDry: Long-Lasting Solution for Excessive Axillary Sweating
August 31, 2016 8:37 AM by Mina Grasso
The embarrassment of excessive sweating (hyperhidrosis) affects approximately more than 7 million individuals, and 4 million individuals suffer from axillary hyperhidrosis. Patients who suffer from excessive sweating have searched for relief, feeling frustrated with various antiperspirants, prescription topical solutions and medications. Prescription medications for hyperhidrosis are effective, however patients will usually use these short term due to undesirable side effects.

Botox injection treatment of hyperhidrosis has been a life-changer for many patients. As I treated patients, I would learn various wardrobe challenges and solutions attempted. Many reported having an extra wardrobe in their trunk, requiring frequent change of clothes due to excessive sweating and odor. Botox injections for excess axillary sweating results are fairly consistent and can last for several months. However it is a costly treatment to maintain. Some patients require Botox injections 2 to 4 times a year.

New alternatives using lasers and energy devices for the treatment of excessive axillary sweating are being researched. Radiofrequency technology using

ThermiDry is now available. ThermiDry is a minimally invasive outpatient treatment with virtually no downtime. Controlled thermal energy is delivered under the axillary skin using radiofrequency, which targets and inactivates axillary sweat-producing glands.

Inactivation of axillary sweat glands produces long-term results. Some have reported 3 years of dryness. The device has not been available very long but is a promising long-term, more economical solution to treating excessive axillary sweating and relieves embarrassing moisture, odor and discomfort.

Unsightly Bra Fat: Kybella Injections Dissolve Fat Cells Non-Surgically
August 17, 2016 8:45 AM by Mina Grasso
Fat bulging around the bra, in the front, back or around the arm pits, can be fashionably limiting to many women. This contributes to multiple wardrobe changes and frustration prior to an event. 

Lifestyle and genetics play a role in the way fat pockets are distributed in the body. Even people within their ideal weight have pockets of fat they can pinch and would love to eliminate or reduce. Bra fat happens to be a common area of increasing demand for fat reduction.

Kybella® injections used to dissolve fat are a non-surgical option to break up and destroy fat cells.  Kybella®, deoxycholic acid, is FDA approved to dissolve submental fat, also known as the "double chin." 

Deoxycholic acid is a naturally occurring molecule in the body that breaks down the fat that we ingest and aids in the absorption of fat. Once injected, a chemical reaction occurs and fat cells are destroyed-permanently. When Kybella® is injected under the chin, a noticeable reduction in fullness is noted and a more defined chin and jawline profile results. Kybella® has been successfully used as an effective solution to treat bra fat as well. 

A series of injections are recommended to obtain full results. The number of treatments and amount of solution used varies depending on the size of area of bra fat to be treated.

The demand for bra fat injections with Kybella® will continue to increase as patients become aware of the simple non-surgical office procedure to destroy unwanted fat pockets permanently.

Hair Loss Treatment Strategies for Men and Women
July 20, 2016 8:19 AM by Mina Grasso
Psychological observational studies have consistently revealed that it takes only a few seconds to form an impression of a stranger from their facial appearance. Within a few seconds, impressions of personality traits and age are made.

Men and women with thinning hair or patterns of baldness are perceived to be older. Hair loss greatly impacts self-image, self-esteem, body image satisfaction and well-being. Hair loss progresses if left untreated. Some common causes of hair loss include, but are not limited to, genetics, testosterone conversion to DHT, other hormonal imbalances and physical and emotional stress.

More advanced strategies are available to slow the progression of hair loss and stimulate regeneration of hair:

1. Propecia (Finasteride)-Clinically proven to suppress DHT (Potential adverse sexual side effects and depression.)

2. Stimulate/regenerate hair follicles

  • Topical hair stimulating cocktails, which may include minoxidil, tretinoin, bimatoprost, herbal preparations
  • Laser Therapy-In office therapy or a home device
  • PRP/PRFM-Platelet rich plasma or platelet rich fibrin matrix use plasma that contains a concentrated amount of platelets, which function to repair tissue. PRP can be activated by the body's own collagen to release growth factors. When calcium chloride or thrombin is used to activate the plasma, platelets release growth factors more slowly. The slower release is felt to enhance the activity of the platelets for a longer period of time. When growth factors are released, they stimulate localized cells to repair and induce synthesis of healthy new tissue. When platelet rich plasma is used on the scalp, they stimulate dormant hair follicles to regenerate fuller, thicker and new healthy appearing hair.

3. Hair Transplantation-Over the years, technological advances have allowed men and women to experience more natural solutions than a few decades ago.

4. Hair Growth Supplements-Overall health is based on nutrients that we take in. A drug-free hair growth supplement with key nutrients called Viviscal Professional can help promote existing hair growth.

5. Combination Therapy-Depending on the degree of hair loss progression, more than one of these strategies can be used together.

Treatment strategies for hair loss should be considered with the first signs of hair loss. Clinical studies using these strategies have been proven to be beneficial and provide superior results when intervention happens in the early stages of hair loss.
Developments for Platelet Rich Plasma in Aesthetics and Sexual Health
July 6, 2016 8:42 AM by Mina Grasso
Platelet rich plasma (PRP)  has been popularized in sports medicine by injured star athletes. PRP is used to augment the body's natural healing response. Supraphysiologic concentrations of platelet rich plasma are used to facilitate tissue repair, relieve symptoms of pain and improve function by modulating inflammation of injured tendons, ligaments and joints. 

Several fields of medicine, including wound care, ophthalmology, dentistry, maxillofacial surgery, urology, dermatology and cosmetic surgery, use this technology to treat various conditions in their specialties.

PRP has been part of our armamentarium for skin rejuvenation for several years. Patients frequently return for the brilliant "glow" they experience for a few days after their treatment. PRP can be delivered alone, injected directly into the skin, combined with hyaluronic acid or applied during microneedling or fractional CO2 laser resurfacing to enhance the rejuvenation. 

Platelet derived growth factors are released from the alpha granules in platelets after activation with thrombin, calcium or the tissue's own collagen. The growth factors and cytokines involved include the following:  

            BFGF-Basic fibroblast growth factor

            ECGF-Endothelial cell growth

            IGF-Insulin-like growth factor

            PD-EGF-Platelet-derived epidermal growth factor

            PDGF-Platelet-derived growth factor

            TGF-Transforming growth factor

            VEGF-Vascular endothelial growth factor

Cell proliferation, cell differentiation (unipotent stem cells) and angiogenesis occur.

Platelet rich plasma involves concentrating the platelets about one-and-a-half times for skin rejuvenation purposes. Various areas where skin rejuvenation is desired and PRP is used include the face, neck, décolleté, arms, legs and breasts. A recent article published in March 2016 in the Daily Mirror demonstrated a "Vampire Breast Lift" to benefit areas of irregularities and asymmetry of the breasts. PRP is used to improve the appearance of post-surgical scars as well as improve sensation.   Multiple studies are proving PRP to stimulate nerve regeneration.   

The latest exciting area in sexual health is PRP for vaginal rejuvenation called the O-Shot. It is effective in treating urinary incontinence as well as enhancing orgasms.

Patients are attached to platelet rich plasma procedures, because PRP utilizes their own natural regenerative abilities. Autologous PRP injected into tissue contributes to collagenesis, angiogenesis, as well as neurogenesis, resulting in healthier, more youthful tissue with improved sensation.



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    Occupation: Physician Assistant/Nurse Practitioner
    Setting: Miami & Upland, Calif.
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